Microvascular protection is essential for successful neuroprotection in stroke

Currently, the best way of neuroprotection for acute ischemic stroke appears to be restoration of blood flow to the ischemic area by thrombolysis. Unfortunately, a short therapeutic time window as well as thrombolysis‐induced bleeding and edema limit the use of recanalization therapies. Here, we rev...

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Bibliographic Details
Published in:Journal of neurochemistry 2012-11, Vol.123 (s2), p.2-11
Main Authors: Gursoy-Ozdemir, Yasemin, Yemisci, Muge, Dalkara, Turgay
Format: Article
Language:English
Subjects:
Animals
Blood vessels
Blood-Brain Barrier - drug effects
Blood-Brain Barrier - physiology
Brain
cerebral ischemia
Humans
Microvessels - physiology
Neurochemistry
Neuroprotective Agents - therapeutic use
neurovascular unit
nitric oxide
Nitrogen Oxides - metabolism
no-reflow
Oxidative stress
Oxidative Stress - drug effects
Oxidative Stress - physiology
pericyte
peroxynitrite
Reperfusion Injury - drug therapy
Reperfusion Injury - prevention & control
Stroke
Stroke - pathology
Stroke - physiopathology
Stroke - therapy
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Summary:Currently, the best way of neuroprotection for acute ischemic stroke appears to be restoration of blood flow to the ischemic area by thrombolysis. Unfortunately, a short therapeutic time window as well as thrombolysis‐induced bleeding and edema limit the use of recanalization therapies. Here, we review the evidence suggesting that ischemia/reperfusion‐induced microvascular injury plays a critical role in determining tissue survival after recanalization in focal cerebral ischemia by disrupting the blood–brain barrier integrity and promoting microcirculatory clogging. Among many complex mechanisms of the ischemia–reperfusion injury, overproduction of oxygen and nitrogen radicals on the microvascular wall appears to significantly contribute to these pathological processes. These developments bring about the exciting possibility that effective suppression of oxidative/nitrative stress during pharmacological or interventional re‐opening of the occluded artery may significantly improve the outcome of recanalization therapies in stroke patients by improving microcirculatory reflow as well as by preventing hemorrhagic conversion and vasogenic edema. They also point to the critical (but partly neglected) importance of the microcirculation in neuroprotection.
ISSN:0022-3042
1471-4159
DOI:10.1111/j.1471-4159.2012.07938.x